Hemorrhoids
Understanding Hemorrhoids
Diagnosing Hemorrhoids
Thrombosed Hemorrhoids
Treating Hemorrhoids: Self-Care
Treating Hemorrhoids: Removal
Treating Hemorrhoids: Surgery
Understanding Hemorrhoids
Hemorrhoid tissues are “cushions” of blood vessels that swell slightly during bowel movements. Too much pressure on the anal canal can make these tissues remain enlarged and cause symptoms. This can happen both inside and outside the anal canal.
Parts of the Anal Canal
- Internal hemorrhoid tissue is in the upper area of the anal canal.
- The rectum is the last several inches of the colon. This is where stool is stored prior to bowel movements.
- Anal sphincters are ring-shaped muscles that expand and contract to control the anal opening.
- External hemorrhoid tissue lies under the anal skin.
- The anus is the passage between the rectum and the outside of the body.
Normal Hemorrhoid Tissue
Hemorrhoid tissues play an important role in helping your body eliminate waste. Food passes from the stomach through the intestines. The waste (stool) then travels through the colon to the rectum. It is stored in the rectum until it’s ready to be passed from the anus. During bowel movements, hemorrhoids swell with blood and become slightly larger. This swelling helps protect and cushion the anal canal as stool passes from the body. Once the stool has passed, the tissues stop swelling and return to normal.
Problem Hemorrhoids
Pressure due to straining or other factors can cause hemorrhoid tissues to remain swollen. When this happens to the hemorrhoid tissues in the anal canal they’re called internal hemorrhoids. Swollen tissues around the anal opening are called external hemorrhoids. Depending on the location, your symptoms can differ.
- Internal hemorrhoids often occur in clusters around the wall of the anal canal. They are usually painless. But they may prolapse (protrude out of the anus) due to straining or pressure from hard stool. After the bowel movement is over, they may then reduce (return inside the body). Internal hemorrhoids often bleed. They can also discharge mucus.
- External hemorrhoids are located at the anal opening, just beneath the skin. These tissues rarely cause problems unless they thrombose (form a blood clot). When this occurs, a hard, bluish lump may appear. A thrombosed hemorrhoid also causes sudden, severe pain. In time, the clot may go away on its own. This sometimes leaves a “skin tag” of tissue stretched by the clot.
Hemorrhoid Symptoms
- Pain or a burning sensation
- Bleeding during bowel movements
- Protrusion of tissue from the anus
- Itching around the anus
Causes of Hemorrhoids
There’s no single cause of hemorrhoids. Most often, though, they are caused by too much pressure on the anal canal. This can be due to:
- Chronic (ongoing) constipation
- Straining during bowel movements
- Sitting too long on the toilet
- Strenuous exercise or heavy lifting
- Pregnancy and childbirth
- Aging
- Diarrhea
Diagnosing Hemorrhoids
To diagnose hemorrhoids, your doctor will rule out other problems and determine how bad your hemorrhoids are. After the evaluation, your doctor will help you decide on a treatment plan that’s best for you.
Medical History
A medical history helps your doctor learn more about your symptoms and overall health. This often includes questions about your bowel habits and diet. You may also be asked how often you exercise and whether you take any medications. Be sure to mention if any members of your family have had cancer or polyps of the colon.
Physical Exam
During a physical exam, you’ll be asked to lie on an exam table. You’ll then be examined for signs of swollen hemorrhoids and other problems. The exam takes just a few minutes. It is usually not painful.
- A visual exam is used to view the outer anal skin.
- A digital rectal exam is used to check for hemorrhoids or other problems in the anal canal. It is done using a lubricated gloved finger.
- An anoscopic exam is done using a special viewing tube called an anoscope. The scope helps your doctor view the anal canal.
Grading Hemorrhoids
Based on the physical exam, your doctor may assign a grade to internal hemorrhoids. The grades are based on the severity of your symptoms.
- Grade I hemorrhoids do not protrude from the anus. They may bleed, but otherwise cause few symptoms.
- Grade II hemorrhoids protrude from the anus during bowel movements. They reduce back into the anal canal when straining stops.
- Grade III hemorrhoids protrude on their own or with straining. They do not reduce by themselves, but can be pushed back into place.
- Grade IV hemorrhoids protrude and cannot be reduced at all. They can also be painful and may require prompt treatment.
Pregnancy and Hemorrhoids
Many women develop hemorrhoids during pregnancy and childbirth. This is likely caused by pressure on the pelvis and by hormonal changes. In most cases, the hemorrhoids will eventually go away on their own. In the meantime, talk with your doctor about ways to help relieve your symptoms.
Other Anal Problems
Below are common problems that can cause symptoms similar to hemorrhoids. Your doctor can explain your treatment options.
- A fissure is a small tear or crack in the lining of the anus. It can be caused by hard bowel movements, diarrhea, or inflammation in the rectal area. Fissures can bleed and cause painful bowel movements.
- An abscess is an infected gland in the anal canal. The infected area swells and often causes pain.
- A fistula is a pathway that may form when an anal abscess drains. The pathway may remain after the abscess is gone. Fistulas are not usually painful. But they can cause drainage where the pathway meets the skin.
Thrombosed Hemorrhoids
Hemorrhoids are swollen veins in the lower rectum and anus. They're similar to varicose veins that form in the legs. Hemorrhoids can occur inside the rectum (internal hemorrhoids). Or one may form at the anal opening (external hemorrhoids). Although they may bleed, most hemorrhoids aren't cause for concern. But a small blood clot (thrombus) can develop in an external hemorrhoid. This may lead to severe pain and sometimes bleeding.
When to Go to the Emergency Room (ER)
If you have severe pain or excessive bleeding, seek immediate medical care.
What to Expect in the ER
A doctor is likely to check your anus and rectum using a slender, lighted tube (anoscope or proctoscope). A local anesthetic is given to ease any discomfort.
Treatment
- If the blood clot has formed within the past 48 to 72 hours, your doctor may remove it from within the hemorrhoid. This is a simple procedure that can relieve pain. You will have a local anesthetic to keep you pain-free during the procedure. A small incision is made in the skin, and the blood clot is removed. Stitches are generally not needed.
- If more than 72 hours have passed, your doctor will suggest home treatments. Simple home treatments can relieve your pain. These may include warm baths, ointments, suppositories, and witch hazel compresses. Many thrombosed hemorrhoids go away on their own in a few weeks.
- If you have persistent bleeding or painful hemorrhoids, talk to your doctor about possible treatment with banding, ligation, or removal (hemorrhoidectomy).
Tips for Preventing Hemorrhoids
- Eat foods that are high in fiber and use fiber supplements to help prevent constipation.
- Drink plenty of liquids.
- Get regular exercise to help prevent constipation and promote good bowel function.
Treating Hemorrhoids: Self-Care
Follow your doctor’s advice about caring for your hemorrhoids at home. Some treatments help relieve symptoms right away. Others involve making changes in your diet and exercise habits. These can help ease constipation and prevent hemorrhoid symptoms from coming back.
Relieving Symptoms
Your doctor may prescribe anti-inflammatory medication to help ease your symptoms. The following tips will also help relieve pain and swelling.
- Take Sitz Baths. Taking a sitz bath means sitting in a few inches of warm bath water. Soaking for 15–20 minutes twice a day can provide welcome relief from painful hemorrhoids. It can also help the area stay clean.
- Develop Good Bowel Habits. Use the bathroom when you need to. Don’t ignore the urge to go. This can lead to constipation, hard stools, and straining. Also, don’t read while on the toilet. Sit only as long as needed. Wipe gently with soft, unscented toilet tissue or baby wipes.
- Use Ice Packs. Placing an ice pack on a thrombosed external hemorrhoid can help relieve pain right away. It will also help reduce the blood clot. Use the ice for 15–20 minutes at a time. Keep a cloth between the ice and your skin to prevent skin damage.
- Use Other Measures. Laxatives and enemas can help ease constipation. But use them only on your doctor’s advice. For symptom relief, try using cotton pads soaked in witch hazel. These are available at most drugstores. Over-the-counter hemorrhoid ointments and petroleum jelly can also provide relief.
Add Fiber to Your Diet
Adding fiber to your diet can help relieve constipation by making stools softer and easier to pass. To increase your fiber intake, your doctor may recommend a bulking agent, such as psyllium. This is a high-fiber supplement available at most grocery and drugstores. Eating more fiber-rich foods will also help. There are two types of fiber:
- Insoluble fiber is the main ingredient in bulking agents. It’s also found in foods such as wheat bran, whole-grain breads, fresh fruits, and vegetables.
- Soluble fiber is found in foods such as oat bran. Although soluble fiber is good for you, it may not ease constipation as much as foods high in insoluble fiber.
Drink More Water
Along with a high-fiber diet, drinking more water can help ease constipation. This is because insoluble fiber absorbs water, making stools soft and bulky. Be sure to drink plenty of water throughout the day. Drinking fruit juices, such as prune juice or apple juice, can also help prevent constipation.
Get More Exercise
Regular exercise aids digestion and helps prevent constipation. It’s also great for your health. So talk with your doctor about starting an exercise program. Low-impact activities, such as swimming or walking, are good places to start. Take it easy at first. And remember to drink plenty of water when you exercise.
High-Fiber Foods
High-fiber foods offer many benefits. By making your stools softer, they help heal and prevent swollen hemorrhoids. They may also help reduce the risk of colon and rectal cancer. Best of all, they’re usually low in calories and taste great. Here are some examples of fiber-rich foods:
- Whole grains, such as wheat bran, corn bran, and brown rice.
- Vegetables, especially carrots, broccoli, cabbage, and peas.
- Fruits, such as apples, bananas, raisins, peaches, and pears.
- Nuts and legumes, especially peanuts, lentils, and kidney beans.
Easy Ways to Add Fiber
The tips below offer some simple ways to add more high-fiber foods to your meals.
- Start your day with a high-fiber breakfast. Eat a wheat bran cereal along with a sliced banana. Or, try peanut butter on whole-wheat toast.
- Eat carrot sticks for snacks. They’re easy to prepare, taste great, and are low in calories.
- Use whole-grain breads instead of white bread for sandwiches.
- Eat fruits for treats. Try an apple and some raisins instead of a candy bar.
Treating Hemorrhoids: Removal
If your symptoms persist, your doctor may recommend removing the hemorrhoid. This can be done in your doctor’s office or at a surgical center. In most cases, no special preparation is needed. Keep in mind that your treatment may differ depending on your symptoms and the location of the hemorrhoid.
Internal Hemorrhoids
Banding
Infrared Coagulation
Sclerotherapy
You’ll be asked to lie or kneel on a table. Your doctor then inserts an anoscope to view the anal canal. To treat the hemorrhoid, your doctor will use one of the methods listed below. Because internal hemorrhoids do not have nerves that sense pain, you won’t have too much discomfort. You can often return to your normal routine the same day. If you have many hemorrhoids, you may need repeated treatments.
Banding
The banding method is done by placing tight elastic bands around the base of the hemorrhoid. This cuts off blood supply to the hemorrhoid, causing it to fall off. This usually takes about a week. The area then heals within a few days.
Infrared Coagulation
This procedure is done using a small probe that exposes the hemorrhoid to short bursts of infrared light. This seals off the blood vessel, causing it to shrink. Slight bleeding may occur for a few days. The area usually heals within a week or two.
Sclerotherapy
Sclerotherapy is done by injecting a chemical into the tissue around the hemorrhoid. The chemical causes the hemorrhoid to shrink within a few days. Bleeding usually stops in about 24 hours.
Thrombosed External Hemorrhoids
External hemorrhoids are often very painful. That’s because the swollen hemorrhoid stretches the sensitive skin around it. To relieve the pain, your doctor may remove the blood clot. This takes just a few minutes. You may need to rest for a few days before returning to work.
- Numbing the Hemorrhoid: You’ll be asked to lie or kneel on a table. The hemorrhoid is then injected with a local anesthetic. This may cause some discomfort for a moment. But within a short time your doctor will be able to remove the hemorrhoid without causing pain.
- Removing the Hemorrhoid: A small incision is made to remove the blood clot. The hemorrhoid may also be removed. The skin is then either closed with sutures or left open to heal on its own. The area around the incision will likely be sore for a few days. But your pain should improve soon after the procedure.
- ULTROID®: Please see our link for information about this minimally invasive OUTpatient procedure offered at the Institute.
Risks and Complications
The possible risks and complications include:
- Infection
- Bleeding
- Trouble urinating
- Narrowing of the anal canal (very rare)
When to Call Your Doctor
After your procedure, call your doctor if you have:
- Increasing pain
- Fever or chills
- Persistent bleeding
- Trouble urinating
Treating Hemorrhoids: Surgery
Your doctor may recommend surgery to remove hemorrhoids that cause severe symptoms. Your doctor can explain the procedure that will be used. You’ll also be told how to get ready for surgery, and what to expect while you recover.
Getting Ready for Surgery
Your surgery will be done at a hospital or surgical center. Be sure to follow all your doctor’s guidelines to prepare for surgery.
- Tell your doctor what medications you take. This includes aspirin and ibuprofen. Also mention if you take any herbal remedies or supplements. In some cases, you may need to stop taking them a week or two before surgery.
- Stop smoking.
- Arrange for an adult family member or friend to give you a ride home after the procedure.
- Stop eating and drinking before midnight, the night before your surgery.
Risks and Complications
The possible risks and complications of the treatments described on these pages include:
- Infection
- Bleeding
- Trouble urinating
- Narrowing of the anal canal (very rare)
When to Call Your Doctor
After surgery, call your doctor if you have any of the following:
- Increasing pain
- Persistent bleeding
- Fever or chills
- Inability to move your bowels
- Trouble urinating
The Day of Surgery
Arrive at the hospital or surgery center on time. You will be asked to sign some forms and change into a patient gown. You’ll then be given an IV (intravenous line), which supplies fluids and medication. You may also be given a laxative or enema to clean stool from your rectum. Just before surgery, you’ll talk with an anesthesiologist. He or she can explain the type of medication used to prevent pain during surgery.
- Local anesthesia numbs just the surgical area.
- Monitored sedation makes you relaxed and drowsy.
- Regional anesthesia numbs certain areas of your body.
- General anesthesia lets you sleep during the procedure.
During Surgery
Sutures may be used to close your incision. These help the area heal.
Staples help prevent tissue in the anal canal from sagging and prolapsing.
Your doctor will insert an anoscope to view the anal canal. Using surgical tools, the swollen hemorrhoids are then removed. In some cases, the incision is closed with sutures. In other cases, you may have a procedure that closes the incision with staples.
Hemorrhoidectomy with Sutures
The hemorrhoids are removed using surgical tools, such as a scalpel or cautery (sealing) device. The incision is then closed with sutures. In some cases, the incision may be left partially open. This allows fluid to drain and helps the healing process.
Stapled Hemorrhoidopexy
This procedure uses a special device to remove a ring of tissue from the anal canal. Removing the tissue cuts off blood supply to the hemorrhoids, causing them to shrink. The tissue ring is then secured with staples. This helps hold the tissue in place.
After Surgery
You’ll be taken to a recovery area to rest for a while. You can usually go home the same day. But in some cases you may need to remain in the hospital overnight. For a short time after surgery you may have nausea, minor bleeding, and discharge. You’ll also likely have some pain. To help you feel better, your doctor will prescribe pain medication. You may also be prescribed medications to help make bowel movements easier.